If difficult airway is anticipated, what is an appropriate plan?

• A. Plan for awake intubation and have alternative airway devices
• B. Proceed with standard induction without plan
• C. Rely on regional anesthesia
• D. Avoid airway management

Answer: (A)

When a difficult airway is anticipated, the plan should keep the patient breathing and breathing time for securement intact, while keeping options open. Awake intubation achieves this by allowing the airway to be secured while the patient still maintains spontaneous ventilation and airway reflexes. Topical anesthesia and light sedation enable the airway to be evaluated and accessed without deep anesthesia, reducing the risk that induction could make ventilation or intubation impossible.

Having alternative airway devices ready—such as a fiberoptic bronchoscope, video laryngoscope, supraglottic airway devices, and an option for bougies or rapid emergency access if needed—provides layered options if the first method encounters difficulty. This approach minimizes the risk of a cannot ventilate situation and keeps the airway management plan adaptable.

Other options fail to address airway risk adequately: proceeding with standard induction without a plan can lead to loss of spontaneous breathing and a crisis if the airway proves difficult; relying on regional anesthesia avoids airway management during the surgery but does not solve potential airway issues if a block wears off or if airway compromise occurs; and avoiding airway management altogether is unsafe for any procedure requiring airway control.

So, planning an awake intubation with readiness to use alternative airway devices is the safest, most effective approach when a difficult airway is anticipated.